INFIRMARY DISCUSSION SERIES: GI Stasis and Basic Rabbit GI Physiology

[tonyshuman]

The next topic we'll be discussing is GI stasis. I'll talk first about what it is, what I think the best treatment is (home treatment and vet), and what some other protocols are and why they're ok or not.

GI stasis is when the gut of a rabbit stops moving, frequently due to a blockage of some sort in the intestines. The blockage can be anything from gas bubbles to fur to carpet fibers to cardboard to plastic. The object of treatment is to get the blockage out of the way so the ingested matter can keep moving through the GI tract. It is critical for a rabbit's GI tract to move continuously because of the type of diet they eat (low calorie) and the delicate balance of GI bacteria. GI stasis is usually caused by a blockage in the small intestine or colon.

**If your rabbit goes 24 hours without pooping or without eating, that is an emergency that requires an immediate vet visit.**

Symptoms: Lethargy, refusing to eat (more than 6 hours without eating), lack of fecal output (more than 6 hours without pooping), sitting in a hunched position with the belly pressed into the floor, tooth grinding (pain), fur in fecal pellets/strung together with fur, smaller and darker poops

Here are some images of the rabbit GI tract:

(ref: http://homepage.mac.com/mattocks/morfz/rabrefs.html)

From https://secure.vlsstore.com/Media/images/vt/06_05/VT_0605_422A.png


As you can see, the rabbit's digestive system is quite complicated compared to that of a human. It contains an extra part, the cecum, and the colon (large intestine in humans) is divided into two parts (distal and proximal). Food enters the stomach and then passes through the small intestine. Food that is high in undigestible plant material enters the cecum. The cecum is a tract that goes both ways, as it holds high-fiber materials for digestion by bacteria until is is ready to be expelled through the anus as cecotropes which are then reingested. This is how the rabbit gains nutrition from very fibrous plant material. Food that is easier to digest skips the cecum and goes into the small intestine.

Cecotropes look different from feces. Rabbits should eat the cecotropes right as they emerge. Not eating cecotropes is a sign of a diet that is too high in carbohydrates and protein, and can lead to nutritional deficiencies. Fecal pellets are rarely eaten.

In this pic, the bigger round balls are feces, the small grape-like shiny balls are cecotropes. (ref: http://www.petcarevb.com/ceco.html )

These are feces strung together with fur:

ref http://www.flickr.com/groups/bunnyloversunite/discuss/72157600299251247/page2/

A good pictoral guide:
http://www.flickr.com/groups/bunnyloversunite/discuss/72157600299251247/

 

[Maureen Las]

Wow !!!! :thumbupThis is great Claire! I am impressed..

At least with my rabbits if I am going to have issues atall it usually is a GI issue..probably the most common problem ofmost rabbits.

This is a great discussion topic because it is easily treatable if you know what to do anddo it fast and yet it will be deadly if left untreated for even a short time.
it is alsogreat to have a diagram of the GI tract that we can refer to easily.

Maureen

 

[tonyshuman]

Here's my step-by-step instructions for what I do if I suspect a GI issue, ie the bunny won't eat or poo, looks uncomfortable, etc. Keep in mind I've only ever dealt with gas, never full-blown stasis.

If I see funny shaped poos, with lots of hair, or lots of excess cecals one day, I will dose 1g of Bene-Bac to each bunny that might be the source of these strange poos. I usually leave out a plate of thawed pumpkin--1 ice cube worth per bunny. If it's just from shedding or eating something too rich, this will usually cure it and they'll be fine by the time I return from work.

If I suspect gas, I give 1mL of baby simethicone drops, plus 0.6mL meloxicam if I have it, and 1g of simethicone on something tasty if they'll eat it. Gas and stasis can cause a lot of pain, so if the bunny is well-hydrated, the pain meds will help. I also offer a warm rice sock, which is dry rice in an old sock heated in the microwave for 1-2min, and give some gentle tummy massages if the bunny will tolerate it. Electric toothbrushes and vibrating back massagers have been used with good effect for this as well. I try to listen for gas by putting my ear on the bunny's tummy--but a stethoscope would probably be better for this. I also try to keep them moving if I can't hold them and do massages--exercise can help break up gas and get the GI tract moving. Other things I do are refill the hay, especially with oat hay since they prefer it, and new hay smells better, and put out fresh pineapple pieces, canned pumpkin, and pedialyte. Also wet parsley or romaine. This has always worked for my guys because I haven't had the bad luck of actually getting stasis or a serious gas event.

The next thing I would do is continue the simethicone doses--1mL/hr for the next 2 hours, and an additional 1mL dose is fine to give 3 hrs after the last dose. So that would be hour 1: 1mL, hour 2: 1mL, hour 3: 1mL, hour 6: 1mL. If the bunny still seems ill, I would first try force-feeding pedialyte or water, and calling the vet. If you know how to do sub-q fluids and have the supplies, this would be a good time to do some.

If the bunny does not improve, and it has been a full 24 hours since he ate/pooped, or there are any changes in behavior, like signs of pain, listlessness, or being less alert, it's time to go to the vet. The best one to go to is your normal vet who has seen him before. If they're not open, go to whichever emergency vet they recommend, or whichever one you're comfortable with. Stasis in rabbits needs to be treated carefully and some dog/cat vets may not know how to do this, so please be careful what you allow them to do to your bunny.

A common thing that an inexperienced vet will do is prescribe gut motility drugs immediately, which can be harmful to the rabbit. Based on a lot of discussion, and there are many different opinions on the board, I personally would only let the vet give my bunnies gut motility drugs if they have done a GI x-ray and determined from the x-ray that it's the best course. Another thing they may prescribe is a petroleum-based laxative, which is appropriate for cats, but not for rabbits.

I would want the vet to first give sub-q fluids and pain medicine, along with providing heat and massage. The next step would be x-ray and possibly gut motility drugs. A vet should not perform an operation to remove an obstruction or give an enema--these are not good practice in rabbits.

Please feel free to chime in on what you would do for stasis, particularly if you have been through it yourself! It's something that home treatment can remedy in some cases (like angieluv said), and something that you need to be careful about when you go to the vet.

 

[Flashy]

This is awesome

 

[Maureen Las]

Flashy wrote:

This is awesome

I agree..

 

[naturestee]

Great advice!

I do alter my at-home treatments depending on what I feel the cause may be. In general, I push fluids a lot with canned pumpkin and wet veggies being offered. I use this as a daily preventative for any rabbit that is shedding heavily as I've noticed a real difference with it. If the rabbit has already progressed to the stage of not eating/eating very little, I give simethicone and gentle belly rubs right away. It helps to slowly massage from upper belly to the vent area, occasionally tilting the rabbit so it's held with it's rear higher to help gas escape.

If gas treatment doesn't produce effects in a few hours, and it's a bun with dental problems (Mocha or Loki), I go to the vet. Despite regular checkups there could be something hurting their mouths. If it's Fey, who has megacolon, I tend to start Benebac right away (I wait with the others as it's usually just gas and dehydrated fur/poop). As long as she's not exhibiting signs of strong pain or total blockage I'm willing to treat her at home for a few days. Nothing new. It's inherently a slow recovery with occasional relapses, although it helps if I can find a cause such as wisps of alfalfa in her hay, etc, that I can remove.

If the bun is eating some, I'll offer fresh herbs like parsley and mint that are calming on the stomach and have a lot of nutritional value. I also use a Snuggle Safe for warmth. If I need to syringe food or fluids, I usually give apple flavored Pedialyte and Critical Care mixed with canned pumpkin. Sometimes I can trick Fey into willingly eating pumpkin that has a little Critical Care mixed in for added nutrients.

And listen to your gut instincts! If you've dealt with stasis before but this seems "different," maybe it is. Go to the vet.

Edit: Here's the Library info, headed by the article I wrote 2 years ago. Please let me know if you think it should be updated/altered in any way!
http://www.rabbitsonline.net/view_topic.php?id=28622&forum_id=10

 

[Flashy]

Just want to add that in the UK we can't get pumpkin, which is unfortunate.

 

[tonyshuman]

The library article is great! I just wanted to have a place where we can discuss these things, since the library is more of a knowledge database than a place where people can share their own experiences and talk about them.

Brand names for relevant stuff in other countries: (please correct me)
simethicone
US: Mylicon, generic
UK/Canada: Ovol
infant rehydration drink:
US: pedialyte
UK: dioralyte

Note: there are recipes for oral rehydration solutions available on-line, but they aren't as good as using the store-bought ones. They have too much sugar and not all of the minerals/electrolytes that you would find in one of the purchased products. In addition, Gatorade or other sports drinks are not suitable for rehydration of bunnies in stasis due to the high sugar content.

 

[tonyshuman]

Questions for UK members: What probiotics (if any) are available there? Can you get pumpkin baby food and is it any good, or is there too much sugar added to make it beneficial?

 

[tonyshuman]

*bump*